287.2 🩺 國考版

287.2.1 高頻考點

287.2.1.1 Classification

  • Simple, moderate, complex complexity
  • L→R shunt (ASD, VSD, PDA, AVSD) → acyanotic
  • R→L shunt (TOF, TGA, truncus, Eisenmenger) → cyanotic
  • Position/connection (dextrocardia, ccTGA)

287.2.1.2 Eisenmenger Syndrome

  • Reversed shunt from progressive PAH
  • Cyanosis, polycythemia, paradoxical embolism, hyperviscosity
  • Avoid IV lines without filter (air embolism)
  • PAH-specific therapy (bosentan — BREATHE-5)
  • Sotatercept investigated in CHD-PAH (STELLAR sub)

287.2.1.3 Pregnancy mWHO Risk

  • mWHO 1: low (mild PS, small ASD)
  • mWHO 2: small increase (most repaired CHD)
  • mWHO 3: significantly increased (mechanical valve, systemic RV)
  • mWHO 4: avoid pregnancy (Eisenmenger, severe PAH, dilated aorta, severe AS, single vent)

287.2.1.4 Endocarditis Prophylaxis (2017 ACC/AHA, 2024 minor update)

  • Prosthetic valve / repair material
  • Unrepaired cyanotic CHD
  • Repaired CHD with prosthetic < 6 mo
  • Repaired with residual defect adjacent to prosthetic
  • Prior IE
  • Cardiac transplant with valvulopathy

287.2.1.5 Common Complications

  • Arrhythmias (#1 cause of late mortality)
  • HF
  • PH
  • Endocarditis
  • Pregnancy complications
  • Cyanotic complications

287.2.1.6 Imaging Pearls

  • CXR: “boot-shaped” TOF; “snowman” TAPVR; “egg on side” TGA; “scimitar” anomalous pulm vein
  • ECG: RBBB post-TOF; LBBB post-VSD repair; AV block post-AVR

287.2.2 易混淆比范

Lesion Shunt Cyanotic? Adult Repair Issues
ASD L→R No RV dilation, AF, PH
VSD L→R No (or Eisenmenger) AR, IE
PDA L→R No Eisenmenger
TOF R→L Yes (untreated) PR post-repair, VT
TGA mix Yes Mustard/Senning baffle, RV failure (systemic RV)
Eisenmenger Reversed R→L Yes PAH-specific therapy
Single ventricle Mixed Variable Fontan complications